In neuralgia of the stomach, called gastralgia, or gastrodynia, the pain is situated in the epigastrium, penetrating to the back. It is distinctly localised and intense. It may be paroxysmal, or there may be dull constant aching with exacerbations of a moderate lancinating character. It is usually relieved somewhat by moderate gentle pressure, but intensified by deep pressure. Such pain is not infrequently associated with anaemia, chronic constipation and hysteria, and in a severe form, accompanied by violent vomiting, it constitutes the "gastric crisis " of locomotor ataxia. Gastralgia may also be occasioned by the continued excessive use of stimulants, such as alcohol, strong tea and coffee, and chewing tobacco, and by the inordinate use of sweets. An excessive formation of hydrochloric acid in the gastric juice may occasion a very painful variety of gastralgia.

Dietetic Treatment

In all cases of gastralgia careful inquiry must be made in regard to irregularities of diet, and the relation between eating and the occurrence of the pain. If the pain is worse while the stomach is empty and is mitigated by taking food, it is suggested by Gowers that it is due to morbid action of those nerves which normally excite hunger. Such cases should be treated by giving nourishment in frequent small quantities. In addition to the three regular meals of the day, which should be light, a glass of wine or a cup of hot bouillon and a biscuit or two, or a glass of milk punch or eggnog, may be taken at 11 a. m., 4 p. m., and again before retiring. A tumbler of milk or a few crackers may be kept by the bedside and taken in the middle of the night should the patient be awakened by the pain. The pain itself is an indication of impoverished nutrition, and the nervous system requires rest while the tissues need food. In still other cases food intensifies the pain and excites immediate emesis. This is especially true of the gastric crises of locomotor ataxia. Here sedatives, such as bismuth, cocaine, or anodynes must be given to relieve the irritation of the gastric mucous membrane while food is temporarily withheld until the pain has subsided.

The diet subsequently should be gradually increased, commencing with small quantities of peptonised albuminous food. In gastralgia the appetite is very capricious, and there may be excessive craving for certain articles of diet, such as pickles, condiments, etc.

In all forms of gastralgia the pain is aggravated by distention of the stomach. If starchy food tends to produce flatulency it should be avoided, together with sugars and fats. Tea and coffee and tobacco must be given up. The bowels should be kept freely open.

Enteralgia - i. e., a true neuralgic pain in the intestines - is not common if " peristaltic unrest" be excluded. It does occur, however, and most frequently in the lower rectum, in which case it is to be relieved by local treatment rather than dieting.

Hepatalgia, or neuralgia of the liver, is an indication of functional overwork of that organ, which may be relieved by a careful inquiry into the dietetic habits of the individual and correction of errors in addition to purgation.

In severe forms of neuralgia which do not yield to dietetic and medicinal control prompt relief is often secured by change of scene and sea bathing, or a course of mineral baths. Hygienic measures improve functional activity and promote oxidation and assimilation by the tissues of the products of digestion, as well as the elimination of waste.